David Munar, the president and chief executive of the AIDS Foundation of Chicago, sounded off in an op-ed for the Huffington Post about the Obama administration reconciling the U.S. debt by negotiating Medicare funding. He writes about how scaling back on Medicare will deeply impact Americans who are living with HIV in this country.

Medicaid expansion for all low-income Americans, regardless of their health status, is the centerpiece of the health reform law championed by President Obama in 2010. Without full funding from the federal government to help states finance Medicaid expansion, low-income individuals -- including hundreds of thousands with and at risk for HIV -- will struggle to gain access to adequate healthcare services from bankrupt Medicaid programs, which will be unable to make up the shortfall in reduced federal funding.

The White House contends that its proposal for a "blended rate" of Medicaid financing for states is far superior to GOP plans to give states a fixed block grant to cover all their low-income healthcare needs, no matter how extensive. While indisputably better than the draconian GOP proposal, a blended rate would likely shortchange states of billions in Medicaid financing that they otherwise would receive under a fully implemented health reform law beginning in 2014. Faced with reduced federal funding, most cash-strapped states will have no choice but to ration healthcare services and further erode already dangerously low provider reimbursement rates.

Munar also discusses how these cuts would negatively impact the AIDS Drug Assistance Program and undermine the goals that the White House National HIV/AIDS Strategy set forth one year ago.

Researchers from Columbia University in New York City found that heterosexual couples that consist of one or two intravenous drug users can reduce their HIV-risk behaviors with the help of couples counseling. This is the first study to test the efficacy of these interventions among HIV-negative straight couples.

Two hundred eighty-two drug-using couples were split up in three groups: couple-based risk-reduction counseling, individual risk-reduction counseling, and the control group that received general health information and screenings for chronic diseases. Most of the couples were approached off the streets and were low-income.

Aidsmap.com reported that researchers had found that couple-based counseling had a significant effect on rates of unprotected sex at month six (30 percent reduction) and month 12 (41 percent reduction).

"These results suggest that when couples receive the intervention together, they are more likely to improve and sustain positive predictive behaviors over time compared to when one partner receives the intervention alone," write the authors.

There were 23 incident sexually transmitted infections during the study and only one participant seroconverted for HIV.

The investigators also found that risk-reduction counselling had a "promising effect" on rates of injecting drug use.

The researchers concluded the following: "These findings draw attention to an effective intervention strategy that can be scaled up for drug-involved couples in harm reduction programs. A couple-based approach to primary prevention of HIV that addresses both drug and sexual risks and targets low income, urban, active drug users may help curb the HIV epidemic in the US and may have dissemination potential to address the global HIV epidemic."

A survey of more than 5,000 men who have sex with men (MSM) from around the world, which was conducted by the Global Forum on MSM & HIV (MSMGF), shows that less than 50 percent of MSM have access to HIV prevention (condoms) and treatment services. The study also found that homophobia served as the strongest predictor of limited access to HIV prevention and treatment. In terms of access to treatment, knowledge and HIV prevention methods, the participants from the Middle East and Asia reported the lowest levels, while in terms of homophobia, participants from Africa reported the highest levels.

The MSMGF press release stated:

Only 36 percent of respondents could easily access HIV treatment, and less than a third reported easy access to behavioral interventions and HIV education materials. Levels of knowledge about emerging prevention technologies were also low. Of all study participants, 39 percent of respondents had never heard of PrEP and 44 percent had never heard of topical microbicides for preventing HIV.

The study also identified key variables that influenced access to HIV prevention services among MSM. Greater access to HIV prevention services was positively correlated with receiving HIV prevention messages and having access to venues that distribute HIV prevention information. Among all variables, the strongest predictor of compromised access to HIV prevention services was the level of homophobia experienced by participants.

"The results of this study lay bare the enormous role that homophobia plays in undermining the global response to HIV," said George Ayala, Executive Officer of the MSMGF. "Even the most effective prevention, care and treatment tools are useless if discrimination prevents gay men from accessing healthcare services in the first place. More than anything, this data is a call to action."

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